(Summary of Changes included in printable PDF below)

CareBridge EVV Integration Guide and Technical Specifications

INTRODUCTION TO CAREBRIDGE INTEGRATION

 

OVERVIEW

Welcome! This Integration Guide is intended to help providers and EVV Vendors throughout the process of integrating with CareBridge to provide EVV data for the purposes of data aggregation. If at any point you have questions, our team here is here to help: evvintegration@carebridgehealth.com.  A PDF of this guide is available here.

WHAT IS CAREBRIDGE?

CareBridge is a company formed to support care for people who receive Long-Term Services and Supports (LTSS). We offer LTSS solutions including an Electronic Visit Verification Platform that can be utilized via a mobile phone, GPS-enabled tablet, landline and web-based portal to record service delivery and facilitate day-to-day management of members’ appointments. CareBridge also supports a wide array of EVV data aggregation solutions in which CareBridge builds an integration with a provider’s EVV system, allowing provider agencies to keep their current EVV solution while still providing required data back to the health plan or state.

INTEGRATION OVERVIEW

CareBridge will engage providers that choose to integrate CareBridge's Platform with a 21st Century Cures Act compliant EVV solution. CareBridge's Platform supports data aggregation by way of accepting EVV Visit Data from third-party vendors and subsequently generating claims to be submitted to the clearinghouse and MCOs.

All EVV Visit and Claims data must ultimately be reflected in the CareBridge Platform for MCO receipt, payment, and monitoring.

The following is a description of the steps in the data aggregation process:

1. Appointments / Visits data file is placed in SFTP folder by provider and/or third-party vendor
2. CareBridge imports and processes Appointments / Visits file
3. CareBridge places response file in SFTP for review by provider and/or third-party vendor
            a.    Provider takes action on response errors and resubmits
4. CareBridge utilizes visits data to generate claims and submits to clearinghouse / MCOs
5. Providers can continue to receive claim remittances through previously established
    mechanisms (Availity)

Appointments / Visits data should be submitted to CareBridge at least once daily for all appointments / visits that have had incremental changes since last submission.

SFTP CONFIGURATION REQUIREMENTS

• CareBridge test environment: sftp.dev.carebridgehealth.com
• CareBridge production environment: sftp.prd.carebridgehealth.com
• Port: 22
• Login Credentials: Vendor's public SSH key
• When transferring files via SFTP, select BINARY mode

SFTP FOLDER STRUCTURE

/input – Used to send files to CareBridge for import into the CareBridge system
/output – Used to retrieve Response Files from CareBridge

SFTP RETENTION POLICY

• Once files have been downloaded from /output, they should be deleted. If they are not
   deleted, they will be retained for 30 days.
• Files will be deleted from /input upon load and processing by CareBridge

FILE FORMAT SPECIFICATIONS

• File type: CSV (pipe-delimited),
• Values can be enclosed with double quotes (and should be when a pipe could exist in the data)
• Headers should be included
• One row per appointment / visit
• All DateTime fields should be UTC with zero offset
• Visit data will be rejected if there is already an existing ApptID that has been claimed but has
   not yet reached a terminal status (Rejected, Paid, Denied)

NAMING CONVENTION

Visit Files from Third Party EVV Vendors

The general naming convention is as follows:
VISITS_NJ_ProviderTaxID_YYYYMMDDHHMMSS.CSV

For Test Files, “TEST” will prepend the file name as follows:
TEST_VISITS_NJ_ProviderTaxID_YYYYMMDDHHMMSS.CSV
Note: The state initials are required for files to be processed.

 

CareBridge Response File

VISITS_NJ_ProviderTaxID_ERROR_YYYYMMDDHHMMSS.txt

For Test Files, “TEST” will prepend the file name as follows:

TEST_VISITS_NJ_ProviderTaxID_ERROR_YYYYMMDDHHMMSS.txt

TESTING INSTRUCTIONS

Testing Overview 

Vendors are required to complete testing scenarios in order to begin sending production data to CareBridge. If a vendor has already completed the integration process in New Jersey and is sending production data for PCS Procedure Codes, additional testing is not required for Home Health.

The goal of the testing process is to ensure that data is able to be successfully transmitted from Third-party vendors to CareBridge. CareBridge has created several test cases designed to ensure specific scenarios are understood and passed by vendors prior to production go-live.

The test cases are outlined in a separate document: New Jersey - Third-Party EVV Vendor Integration Testing Process Guide, available on the CareBridge EVV Data Integration web page: http://evvintegration.carebridgehealth.com, under Additional Documents for Third-Party Vendors > New Jersey  - Third-Party EVV Vendor Integration Testing Process Guide.

Additionally, there are 3 different testing milestones summarized below:

• Connection Testing – Vendors credentials are working properly and they are able to successful connect to the SFTP site.
• File Validation Testing – Vendors are able to successfully send files in accordance with our file specifications.
• Data Validation Testing– Vendors are able to send records in accordance with our data specifications. A full list of CareBridge Pre-Billing Validations can be found under Technical Specifications for Third-Party Vendors > Pre-Billing Validation Errors.

File Validation Testing (Milestone 2)

Once a vendor has successfully completed the required test cases and is approved to send data to production, they can begin sending production appointment/visit data to the production environment.

CareBridge highly recommends that EVV Vendors follow the process outlined below:

1. Send a file in the production environment with actual visit/appointment data.

   a. Only send 1-5 rows of data initially.
   b. Send visit data with the ClaimAction field as null.
   c. At least one row of data should be visit data rather than appointment data.

2. Download the response file in the /output folder and review the pre-billing errors.
3. Update data to remedy those errors; email evvintegration@carebridgehealth.com with questions about specific errors.
4. Repeat steps 1-3 until you receive a response file with headers only. This means that there were no row level errors and the data was processed successfully.
5. Repeat steps 1-4 for each unique provider agency TIN for whom you provide EVV services.

Claim Submitted Via CareBridge

Once a vendor is able to successfully send a file of appointment/visit data without errors on behalf of a provider, they can coordinate with the provider to submit their first claim. Note: for Horizon members, claims will not be submitted via CareBridge.  ClaimAction “E” should be used for Horizon visits.

• Re-send the visit data previously sent in Initial Production Data Go-Live with the ClaimAction field as 'N'. This will generate a claim for those visits.

Note: If visits sent in Data Validation Testing – Production included the ClaimAction field as 'N' rather than null, both Data Validation in Production and Claim Submitted via CareBridge would be completed simultaneously.

Integration "Go-Live" 

Once a vendor is able to successfully submit a claim via CareBridge, they can begin implementation of Integration Go-Live – submitting all claims via CareBridge.

This will require coordination between the vendor, the agency(ies) they support and CareBridge.

The process is as follows:

1. Direct providers using your system to the CareBridge Integration Document for Providers site. It contains instructions for their expectations and next steps.
2. Identify a go-live date with each agency to begin sending all data and communicate that date to CareBridge.
3. Develop a process with your agency for resolving response file errors on an ongoing basis.
   • It is up to vendors and their agencies whether response files will be passed to their agencies directly or incorporated into the Third-party EVV system’s UI.
   • It is required that vendors leverage both the:
     1.  
        1.  
           1. The Pre-Billing Validation Report in addition to response files to ensure providers have the most up-to-date information regarding outstanding visit errors.
           2. The Appointment Status Report to ensure providers have accurate information regarding visit or claim status over time.
              •  
                • The supplemental report specifications can be found on the CareBridge EVV Data Integration web page: http://evvintegration.carebridgehealth.com, under Additional Documents for Third-Party Vendors.
   • Integrating agencies will not be able to make updates to their data in the CareBridge EVV portal. Updated data should be sent via integration process.

DATA FIELD SPECIFICATIONS

CareBridge Response File Format

In addition to these 5 fields, the CareBridge response file will also contain each field included in the inbound data file for Third-Party EVV Vendor reference.

File Level Validation

Appointments / Visits Data File Format

1 ClaimAction "N" operates as the marker to generate both a new claim or a corrected claim based on previously submitted aggregate data. 

PCS Service Codes and Unit Definitions

Home Health Service Codes and Unit Definitions*

^{1 Please see section for Primary and Add-On Service Codes}

^{2 Per Diem Units are always billed as a single unit with a maximum of 1 unit per day.}

^{3 For Horizon and Wellpoint, there are no validations on Modifiers, up to 4 modifiers are allowed for Wellpoint.  Up to 2 modifiers will be passed to Horizon. For Horizon, providers should ensure that Modifiers match what has been claimed to Horizon. For Wellpoint, even if no modifiers are listed in the table above, all modifiers are allowable to be included on visit data.}

^{4 AuthRefNumbers are required for all Procedure Codes for Wellpoint New Jersey.  From a system perspective, all Horizon Home Health Service Codes are treated as "Sometimes" authorized.}

Home Health Service Codes and Revenue Codes*

^{* Revenue Codes should only be used for Wellpoint New Jersey services.} 

Member Attestation Codes

Manual Reasons Codes

Late Reasons Codes

Late Reason Actions Taken Codes

Missed Reasons Codes

Missed Visit Actions Taken Codes

MCOID Codes^* 

Primary and Add On Service Codes

• Primary/Add On Service Codes (99601/99602 and 97129/97130) are service codes that have explicit divisions required for billing purposes. These services do not need to be divided from an EVV perspective. For example, if three hours of infusion services are provided, then first two hours are billed under 99601 and the last hour should be billed under 99602.

Wellpoint New Jersey

• The examples and rules below utilize 99601/99602, but identical logic applies for 97129/97130 (with the relevant unit type being per 15 mins rather than hourly).
• Providers must have both primary and add-on service codes authorized in order for billing to function correctly in all cases. If only one of the primary or add-on service code is authorized, the provider should reach out to Wellpoint New Jersey.
• From an EVV data perspective, it would be acceptable to send the entire visit using 99601. If the visit is longer than two hours, when the claim is generated, CareBridge will automatically apply the following rules:

Example 1 - Single Visit, More than 2 Hours

Rule: Claims for 99601/99602 for each billing provider/member/authorization, will be billed as separate claim lines on the same claim.

Example 2 - Single Visit, Less than 2 hours

Rule: If only one visit is received for a calendar day (for each billing provider/member/authorization), the first two hours will be billed under 99601 and any additional hours will be billed as 99602.

Example 3 - Multiple Visits, Initial Visit Less than 2 hours

Rule: If multiple visits are received for a calendar day, and the first visit is less than two hours, then that visit will be billed under 99601 and the additional visits will be billed under 99602 with units rounding up for each hour.

Example 4 - Multiple Visits, Initial Visit more than 2 Hours

Rule: If multiple visits are received for a calendar day, and the first visit is longer than two hours, then the first two hours of that visit will be billed under 99601 and the remaining duration of that visit will be combined with any additional visits and the total additional duration will be billed under 99602 with units rounding up for each hour.

Example 5 - Single Visit, Overnight

Rule: If a visit spans midnight, then the logic above will be applied, but all of the units will be billed on the initial date of service. This ensures that 99602 is not billed separately from 99601.

Horizon

• Visits for Primary and Add-On service codes for Horizon members should be sent to CareBridge in accordance with the way that they are claimed to Horizon.

Pre-Billing Validations

Pre-billing checks are performed in the CareBridge system to ensure that clean claims are generated and that EVV Data is valid.  If validation errors are present in response files or appointment error files, they must be resolved by the agency or vendor prior to claim generation.

A full list of CareBridge Pre-Billing Validations can be found under Technical Specifications for Third-Party Vendors > Pre-Billing Validations